OTA 2: Lecture 6Mental HealthTraumatic Brain InjuryStroke

July 3, 2012

Mental Health, TBI & Stroke Brain-based, but distinct from one

another 1st half of class: Mental health▪ Mental health: can be psychologically based or

physically/biologically based

2nd half of class: Intro to TBI and Stroke• Biologically or physiologically based

Mental Health: Occupational Therapy and OTA Role

Occupational therapists address barriers to mental health by creating home, work and community environments that facilitate meaningful occupation

(CAOT Position Statement) Under the direction of the OT, the

OTA assists the OT in the application of research, best practices, the recovery model, and demonstration of outcomes.

Source: http://www.providencecare.ca/objects/content_revision/download.cfm/revision_id.205934/workspace_id.-4/Occupational%20Therapy%20-%20Mental%20Health%20Services.pdf/

Mental Health and OT

Found in: Community OT Mental Health facilities Community facilities Long-term Care facilities Forensic systems (Prisons) Everyday client populations dealing with

physical dysfunction

Psychosocial Aspects of Physical Disability Chapter 3 (Early Text) Experience of loss can be profound

Especially in relation to ROLE LOSS Effects both:

Client Client’s family & friends

Key Factors Influencing Psychosocial Effect of Disabilty

1. Time of life and developmental stage2. Extent and location of deficit3. Is deficit obvious?4. Social definition of the deficit5. Attitudes of family/loved ones6. Extent to which disability affects functioning7. Disruption of valued goals

** visit these factors in your regular interactions and conversations with clients**

Consider the Model of Human Occupation (MOHO)

What skills, habits, and roles has this person lost or reduced as a result of the disability?

What is the person’s sense of personal causation?

What values and interests does this person have?

What is the person’s social and object environment?

What interventions will increase the person’s sense of personal causation and put the environment more within his/her control?

Role Checklist: Homework Oakley, 2006 Based on the MOHO Review the instructions and

complete the checklist for yourself. I do not want a copy of the results,

but I would like you to hand in a paragraph reflecting on what you thought of the results.

Psychosocial Consequences of Acquired Physical Dysfunction Different from congenital dysfunction. Both are equally valid and may surface during

treatment, but more likely to surface with OT with acquired injuries

Affected by: Personal reactions: Feelings of self-worth,

Acceptance of disability▪ Address with: personalized approaches to golas and

treatment objectives Societal reactions: Attitudes, Appearances, (own)

vulnerability▪ Address with: education, collaboration, advocacy

Barriers to Healthy Adjustment Non-acceptance

Person with disability not accepted into society: no place

Examples? Spread factor

Evaluation of the visible disability is spread to other characteristics not affected

Examples? Labelling/Stigmatization

Language: retard, crip, psycho, quad…

Adjustment to Disability: Kerr Coping mechanisms and response patterns Analogous to Kubler-Ross grief processes

1. SHOCK: “this isn’t me!”2. EXPECTANCY: “I’m sick, but I’ll get well”3. MOURNING: “All is lost”4. DEFENSIVE:

1. Healthy: “I’ll go on in spite of ___”2. Pathological: marked use of defense to deny the

effects of the disablity5. ADJUSTMENT: “It’s different, but not bad”

How do these stages of adjustment play out? You may see a variety of coping

mechanisms in practice. The same coping mechanism that is

helpful or healthy in one client may be harmful to another.

The OT will guide how these coping mechanisms are addressed in treatment

Coping Strategies

Projection Displacement Sublimation Aggression Dependency Regression Compensation Fantasy Passing

Key: Self Acceptance and the Recovery Model

Recovery is the personal process that people with mental illness go through in gaining control, meaning and purpose in their lives.

Recovery involves different things for different people. For some, recovery means the complete absence of the

symptoms of mental illness. For others, recovery means living a full life in the

community while learning to live with ongoing symptoms. Recovery involves changes in the way individuals

with mental illness think, act and feel about themselves and the possibilities in their lives (CAMH, 2012).

Exercise:

This lunchtime, wear something embarrassing or use an aid in public while you have your lunch break. When we return, discuss: What coping mechanisms you used to

deal with this small change? What though processes did you go

through?

Break:

See you all at 12:00

Stroke: Cerebrovascular Accident (CVA)

Leading cause of serious long-term adult disability

Caused by a sudden loss of blood supply to the brain

Blood loss/loss of oxygen leads to damage and death of brain cells

Results in deficits relating to these areas of the brain

Remember: stroke to one side of the brain results in deficits in the opposite side of the body

Dysfunction:

Immediately after stroke: Flaccid paralysis Hypotonicity (low muscle tone) Impaired posture control Sensory deficits Visual impairments Perceptual dysfunction Cognitive dysfunction Behavioral and personality changes Impaired speech and language

Recovery

Outcome depends on many personal, environmental, and health-related factors

Spontaneous recovery of motor function occurs primarily in first 3 months, but can occur up to one year

Improvements in functional ability continually improve with treatment and adjustment

Role of Occupational Therapy Improving the motor function of the

affected side Integrating sensory, visual-

perceptual, and cognitive functions Facilitating maximal level of

functional independence Encouraging return to life roles

Goals of Occupational Therapy For Clients with Stroke

Consider the goals for OT on page 468

Go through your text and find a treatment strategy that will address each of these for a client with stroke.

For this exercise, it need not be something that the OTA will implement, you can consider yourself to be working in collaboration with the OT guiding you for each goal.

Traumatic Brain Injury (TBI) Results from a penetrating or non-

penetrating injury to the brain A spectrum of disability No two clients are the same, despite

the injury TBI is a life-altering experience that

causes physical, cognitive, behavioral, and emotional changes.

Difficult on both clients and families

Levels of Cognitive Functioning:Rancho Los Amigos Scale of Cognitive Functioning

I. No response: Total AssistanceII. Generalized Response: Total AssistanceIII. Localized Response: Total AssistanceIV. Confused-Agitated: Maximal AssistanceV. Confused-Inappropriate, Nonagitated: Maximal

AssistanceVI. Confused-Appropriate: Moderate AssistanceVII. Automatic-Appropriate: Minimal Assistance for Daily

Living SkillsVIII. Purposeful and Appropriate: Standby AssistanceIX. Purposeful and Appropriate: Standby Assistance on

RequestX. Purposeful and Appropriate: Modified Independence

Damage

Primary Damage Occurs at the time of trauma

Secondary Damage Can occur immediately after the injury,

or hours-days later Can be life-threatening Can result in widespread damage

OT in the ICU

Establishing a bed and wheelchair positioning program

Establishing and implementing a sitting program if possible

Preventing contractures Increasing endurance Establishing a baseline cognitive

status Educating the family Facilitating client participation in

basic ADLs

Clinical Picture of a Client with TBI Neuromuscular changes

Deficits in:▪ Primitive reflexes▪ Muscle tone▪ Postural stability▪ Motor control▪ ROM▪ Strength▪ Sensation▪ Endurance

Clinical Picture:

Reduced Attention and Concentration

Impaired initiation Impaired memory Decreased safety awareness Delayed processing of information Impaired executive functioning and

abstract reasoning Changes in behavior Psychosocial changes

Treatment

Client-centred (always) Consider the impact of the changes

to personality To the client themselves (are they even

aware?) To the family

Depends on severity of the injury Refer to your text, there are good ideas

there Role of education

+++ helpful to clients and families